Admission Forms

Cedar Hills Hospital & Outpatient Services value you and your time. We have made assessment forms available for you to complete before your arrive for your appointment in order to expedite your appointment. Please complete the forms below and bring the packet of information with you when you arrive for your assessment.

Patient Information (In Process, not yet available)

A form providing brief demographic information about yourself in order for Cedar Hills to better serve you. Insurance information is requested on this form so please bring your insurance card with you, along with this form completely filled out.

We will respect your privacy at Cedar Hills Hospital & Outpatient Services. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this form carefully.

In order to communicate with others about you or your care at Cedar Hills, we require a signed release of information. This includes family members, professional referral sources / medical providers, friends and anyone else you would like to be able access information about your care and treatment. Please complete this form and bring it with you to your appointment. If you do not want anyone to have access to your information we still require a signed release of information, just leave the area requesting names blank.

PROFESSIONALS

If you are a professional referring a patient to Cedar Hills Hospital or Cedar Hills Outpatient Services, please take a moment to complete a referral form and fax to our admissions department at 503.535.7370 at the hospital or 971.228.8018 at outpatient services; or you can email the form to [email protected].

“TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.”

Cedar Hills Hospital does not exclude, deny benefits to, or otherwise discriminate against any person in the provision of emergency services
on the grounds of race, ethnicity, religion, culture, language, socioeconomic status, ability to pay, sex, sexual orientation, and gender
identity or expression, color, national origin, age or on the basis of physical or mental disability in admission to, participation in, or
receipt of the services and benefits under any of its programs and activities, whether carried out by Cedar Hills Hospital staff directly
or through a contractor of any other entity with which Cedar Hills Hospital arranges to carry out its programs and activities or in employment.

Physicians are on the medical staff of Cedar Hills Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Cedar Hills Hospital. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. Actual patients cannot be divulged due to HIPAA regulations.